BSAPTR PROGRAMS / PROJECTS : YDI
Member Information Form
First Name: Last Name: Date:
Gender: Male Female Age: Date of Birth:
Address:
City: State: Zip:
Home Phone: Cell Phone:    
E-Mail Address:
School: Grade:    
Are you currently in any clubs or activities at your school? If yes, please list:
Are you interested in joining:
Step/Dance Team
YDI Flames Basketball Team
Drama/Performing Arts Troupe
Youth Ambassador Training Program
Why do you want to be involved with the Youth Development Institute?
What activities would you like to see within the Youth Development Institute?
What days and times are you available to participate in YDI activities?
How did you hear about the Youth Development Institute?
Friend/Family Member
Flyer
Website
Agency/Organization
Other
What committee are you interested in being part of?
Fundraising Committee
Event Planning Committee
Membership/Recruitment Committee
Promotions Committee
Parent/Guardian Information:
Parent/Guardian Name:
Address:
Home Phone: Cell Phone:
Work Phone:
E-Mail Address: